| National Provider Identifier [NPI]: | 1629092564 |
| Last Name Of The Provider | VILLA |
| First Name Of The Provider | MARIVIC |
| Middle Initial Of The Provider | D |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 10250 SE 167TH PLACE RD |
| Street Address 2 Of The Provider | SUITE 5 |
| City Of The Provider | SUMMERFIELD |
| Zip Code Of The Provider | 344918686 |
| State Code Of The Provider | FL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Pulmonary Disease |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 164 |
| Number Of Services | 22201 |
| Number Of Medicare Beneficiaries | 1168 |
| Total Submitted Charge Amount | 1720060.56 |
| Total Medicare Allowed Amount | 835376.71 |
| Total Medicare Payment Amount | 639766.3 |
| Total Medicare Standardized Payment Amount | 639462.81 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 28 |
| Number Of Drug Services | 5167 |
| Number Of Medicare Beneficiaries With Drug Services | 484 |
| Total Drug Submitted ChargeAmount | 34213 |
| Total Drug Medicare AllowedAmount | 13032.26 |
| Total Drug Medicare PaymentAmount | 11146.93 |
| Total Drug Medicare Standardized Payment Amount | 11146.93 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 136 |
| Number Of Medical Services | 17034 |
| Number Of Medicare Beneficiaries With Medical Services | 1168 |
| Total Medical Submitted Charge Amount | 1685847.56 |
| Total Medical Medicare Allowed Amount | 822344.45 |
| Total Medical Medicare Payment Amount | 628619.37 |
| Total Medical Medicare Standardized Payment Amount | 628315.88 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 37 |
| Number Of Beneficiaries Age 65 to 74 | 553 |
| Number Of Beneficiaries Age 75 to 84 | 457 |
| Number Of Beneficiaries Age Greater 84 | 121 |
| Number Of Female Beneficiaries | 717 |
| Number Of Male Beneficiaries | 451 |
| Number Of Non Hispanic White Beneficiaries | 1121 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 14 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 13 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1132 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 36 |
| Percent Of With Atrial Fibrillation | 13 |
| Percent Of With Alzheimers Disease or Dementia | 10 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 18 |
| Percent Of With Chronic Kidney Disease | 19 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 24 |
| Percent Of With Depression | 21 |
| Percent Of With Diabetes | 28 |
| Percent Of With Hyperlipidemia | 75 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 46 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 44 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 2 |
| Percent Of With Stroke | 7 |
| Average HCC Risk Score Of Beneficiaries | 1.2319 |